氢吗啡酮联合低剂量异丙嗪在终末期老年癌性疼痛患者中的应用  

The Application of Hydromorphone Combined with Low-dose Promethazine in Elderly Patients with End-stage Cancer Pain

作　　者：杨影[1] 李孝男[1] 李晓男 方艳秋[1] 侯俊杰[1] Yang Ying;Li Xiaonan;Li Xiaonan;Fang Yanqiu;Hou Junjie(Department of Comprehensive Oncology,Jilin Province People’s Hospital)

机构地区：[1]吉林省人民医院肿瘤综合治疗科,长春130012

出　　处：《国际老年医学杂志》2024年第6期680-684,共5页International Journal of Geriatrics

基　　金：吉林省卫生健康科技能力提升项目(2021LC062)。

摘　　要：目的 探讨低剂量异丙嗪联合氢吗啡酮在终末期老年癌性疼痛患者中的应用效果及安全性分析。方法 选取吉林省人民医院2022年4—12月收治的58例终末期老年癌性疼痛患者进行前瞻性研究。按照随机数字表法分为试验组(30例)和对照组(28例),试验组采用低剂量异丙嗪联合氢吗啡酮止痛治疗,对照组采用单药氢吗啡酮止痛治疗。比较两组疼痛情况[数字疼痛分级法(NRS)评估]、氢吗啡酮的日均使用剂量、睡眠质量[匹兹堡睡眠质量指数量表(PSQI)评估]、精神状态[汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评估]及不良反应等。结果 两组治疗后RNS评分较治疗前均有所下降(P<0.05),且试验组低于对照组(P<0.05)。治疗第7天,试验组氢吗啡酮日用量、PSQI评分及HAMD、HAMA评分均低于治疗前(P<0.05),且试验组低于对照组(P<0.05)。试验组便秘、恶心呕吐的发生率低于对照组(P<0.05),嗜睡发生率高于对照组(P<0.05)。结论 氢吗啡酮联合低剂量异丙嗪可以有效缓解终末期老年癌症患者的难治性癌性疼痛,且不良反应可耐受,值得临床推广。Objective To investigate the application and safety analysis of low-dose promethazine combined with hydromorphone in elderly patients with end-stage cancer pain.Methods A total of 58 elderly patients with end-stage cancer pain admitted to Jilin Province People’s Hospital from April 2022 to December 2022 were selected for prospective study,they were randomly divided into an experimental group(30 cases)and a control group(28 cases)according to random number table method.The experimental group received low-dose promethazine combined with hydromorphone for analgesic treatment,and the control group received single drug hydromorphone for analgesic treatment.The cancer pain[numeric rating scale(NRS)],daily dose of hydromorphone,sleep quality assessment[pittsburgh sleep quality index(PSQI)],mental status assessment[Hamilton depression scale(HAMD),Hamilton anxiety scale(HAMA)]and adverse reactions were compared between the two groups.Results The RNS scores of the two groups decreased after treatment compared with those before treatment(P<0.05),and the experimental group was lower than the control group(P<0.05).On the 7th day of treatment,daily dose of hydromorphone,the PSQI score,HAMD and HAMA scores in the test group were lower than those before treatment(P<0.05),and the scores in the experimental group were lower than those in the control group(P<0.05).The incidence of constipation,nausea and vomiting in the experimental group was lower than that in the control group(P<0.05),and the incidence of somnolence was higher than that in the control group(P<0.05).Conclusion Hydromorphone combined with low-dose promethazine can alleviate intractable cancer pain in elderly patients with end-stage cancer,and demonstrate tolerable adverse reactions.Therefore,it is worthy of clinical promotion.

关 键 词：氢吗啡酮 异丙嗪 癌性疼痛 

分 类 号：R730.5[医药卫生—肿瘤]